Wednesday, 14 January 2015

Can nursing handovers be more effective?

Roger Watson, Editor-in-Chief

Nursing handovers are a routine, a ritual almost, between nursing shifts. I recall many different patterns during my time in clinical practice. At one end of the spectrum there was the the mass exodus of the majority of nursing staff to the ward office for a long and quite boring summary of each patient; aimed at everyone at once and nobody in particular with a great deal of irrelevant information included. At the other end of the spectrum - and exemplified on intensive care - one-to-one handovers in considerable detail, all of it easily obtained at a glance form the patient chart. There were varying philosophies about writing things down during handover: some saw this as a potential breach of patient confidentiality if the notes became lost; others expressed surprise that you were not capturing their words of wisdom on a scrap of paper. In any case, questions were discouraged. Whatever model was in operation I felt that they were all a considerable waste of time.

However, nursing handovers are potentially valuable and some modes of conductung them may be safer than others as a recent study published in JAN shows (Drach-Zahavy and Hadid 2015). The study comes from Israel and is titled: 'Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift'. The authors studied 200 randomly selected handovers, including the accompanying documentation, and found a great deal of inaccuracy in terms of medication dosage and missing information. The best model for handover was one that was face-to-face and where an open and questioning attitude was adopted. In the words of the authors: 'Our study presents opportunities for interventions aimed to improve communication during handover. The findings, which support the association between specific handover strategies, errors and handover quality, suggest the integration of flexibility alongside standardized procedures.'